The Insurance Clerk II is responsible for accounts receivable functions for insurance plans and third party payors, under the guidance of regulatory and contractual requirement, reviewing changes or updates to regulatory requirements and working with third party payers to resolve claim issues.
Successful Candidate will have:

• Prepare and file insurance claims in accordance with insurance carrier's regulatory and contractual requirements
• Review, correct and reconcile rejections from clearing house or CIMOR system.
• Review, reconcile and post remittance advices (RA) or explanations of benefits (EOB) as received for assigned insurance carriers.
• Process, correct or adjust denied claims and overpayments for assigned insurance carriers.
• Work with other departments to obtain insurance information as needed to file or correct claims for assigned insurance carriers.
• Review and process open items reports for assigned insurance carriers.
• Work with insurance plans and third party payors to resolve claim issues for assigned insurance carriers.
• Verify Insurance eligibility for scheduled appointments.
• Process collection of deductibles and co-insurance for insurance carriers assigned.
• Review insurance bulletins, email updates and website updates for changes in requirements or processes and communicate information to Insurance clerks as applicable.
• Assist insurance clerk 1 with interpretation of insurance regulations and billing guidelines.
• Resolve issues in the EDI process with clearinghouse, insurance carrier, or CIMOR (including insurance and site enrollment.
• Preforms other duties as designed.

Education/Qualifications

• High school graduate or G.E.D.
• Technical School training preferred.
• Two (2) years' experience in insurance accounts receivables or a related field required.
• Must have experience working with Microsoft office products and Web based insurance programs.
• Technical School training preferred.

About Swope Health Services:
Each year, Swope Health serves over 45,000 patients, encompassing more than 200,000 visits in four counties on both sides of the state line. Our team members are proud of the work we do and the promise we've made - delivering coordinated care that values the needs of the whole person and championing better health in our community.
Swope Health is a special place that cares for the people who need it most, wherever they are in the community. As part of our promise to battle health inequities and provide high-quality, comprehensive care, we make care visible. That means we proudly deliver our promise through every action, every day.
Swope Health Services supports its team members with:

• Medical benefits (including a Health Savings Account option), dental and vision
• 401(k) retirement plan with company match
• Company-paid benefits such as life insurance, Accidental Death & Dismemberment, and Short- and Long-Term Disability
• Flexible Spending Account
• Paid Days Off beginning at 12 days annually, effective the first day of employment
• Eight annual company-paid holidays; One annual paid personal day

Swope Health is an affirmative-action, equal-opportunity employer. We consider all qualified applicants without regard to race, color, creed, religion, gender, national origin, age, marital status, veteran status or disability.